Payor Relations Specialist - Inpatient Rehab

Select Medical; Oklahoma City (OK); Remote; USD 55,000 - 75,000; Full time

Job summary

Join a leading rehabilitation hospital as a Payor Relations Specialist, managing pre-certifications and enhancing customer relationships within a collaborative team. Your clinical expertise will support vital services in a remote role, contributing to high-quality patient care and operational success.

Benefits

Generous PTO

Comprehensive medical/RX, health, vision, and dental plans

Company-matching 401(k) retirement plan

Company paid parking

Qualifications

• 2 years of direct experience in third party reimbursement required.
• Must be licensed as a Registered Nurse or LVN/LPN.

Responsibilities

• Manage pre-certification and prior authorization for hospital admissions.
• Ensure documentation meets standards and develops relationships with payers.
• Provide outstanding customer service and collaborate with teams.

Skills

Communication

Teamwork

Customer Service

Analytical Skills

Education

Licensure as a Registered Nurse or LVN/LPN

Tools

Excel

Databases

Job description

Overview

SSM Health Rehabilitation Hospital - Oklahoma City

*A joint venture with Select Medical & SSM Health*

Oklahoma City, OK

Payor Relations Specialist / Prior Authorization Specialist

( RN , LPN )

This is a remote position - must support a hospital in the Central Time Zone

Responsibilities

Job Responsibilities

Using discretion and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute Inpatient Rehabilitation Hospital.

Follows the Select Workflow Process for initiating and completing patient authorizations. Takes full responsibility for following the “Workflow Process” and ensures each referral follows the process, from taking the initial referral until final disposition, acceptance or denial. As appropriate, submits the preadmission assessments completed by clinical liaisons to the insurance company.

Ensures documentation meets standards and expectations by working and mentoring team as needed. Obtains timely authorization of all patients requiring pre-certification and is accountable for conversion percentage and results.

Ensures all policies governing commercial pre-certification and authorization are followed to minimize financial risk. Develops relationships that increase and stabilize conversion as well as generates referrals both locally and regionally. This may include identifying relationship opportunities for self and others within Select Medical to include but not limited to CEO, DBD, CLs, Admissions Coordinator and Case Management team that may help grow relationships and impact results.

Maintains profiles on each payer to include case managers and medical directors, P2P and appeal info.

Identifies by payor communication preference and utilizes to maximize results.

Encourages and models teamwork, communication and collaboration with other departments to include but not limited to the transition of patients into the critical illness recovery hospital or acute inpatient rehabilitation hospital.

Serves as a resource to the Business Development Team educating them on payor preference to promote exceptional customer service and efficient processes

Maintains and further develops relationships with customers which may include but are not limited to surveying for satisfaction with the work of Select Medical and off-site meetings with the customer.

Evaluates Non-Medicare benefits as verified by the Central Business Office or Rehab Admissions Coordinator. Reviews benefits with Admissions Coordinator for possible risk and applies/completes written guidelines as necessary to reduce or manage risk.

Answers phone with appropriate behavior and ensures back-up when not available or out of the office.

Works closely with Admissions Coordinator to apply correct accommodation code per contract as well as billing/reimbursement requirements.

Tracks approval and denials through TOC.

Ensure outstanding customer service for all customers.

Performs other duties as requested.

Qualifications

Minimum Qualifications

• Licensure as a Registered Nurse or LVN/LPN is required
• 2 years of of direct experience in third party reimbursement required

Preferred Experience

• Previous Experience within a physical rehabilitationsetting preferred
• Experience working with Excel and databases

Additional Data

Why Join Us:

• Start Strong:Extensive and thorough orientation program to ensure a smooth transition into our setting.
• Recharge & Refresh:Generous PTO to maintain a healthy work-life balance
• Your Health Matters:Comprehensive medical/RX, health, vision, and dental plan offerings
• Invest in Your Future:Company-matching 401(k) retirement plan, as well as life and disability protection
• Ease The Burden:Company paid parking
• Your Impact Matters:Join a team of over 44,000 committed to providing exceptional patient care

Equal Opportunity Employer, including Disabled/Veterans.